Presentation

Patient Data

Loading Stack -

0 images remaining

Frontal

Large right pleural effusion, likely malignant in nature, patient will benefit from thoracentesis and Pleurx catheter placement.

Bilateral multiple metastatic nodules.

With above history a radiologist should think out of the box for rare complications of a portacath placement. Recommend a fluoro study for evaluation of tip of portacath as the tip on lateral view suggests it has an extrapleural course or it has perforated the SVC and is out into the mediastinum.

Loading Stack -

0 images remaining

frontal

The catheter of the right chest port has an extravascular course for its entire length and the tip of the catheter terminates in the mediastinum/pleural space. The contrast flows into the posterior right pleural space.

Loading Stack -

0 images remaining

VR

A right chest wall port has been placed. The catheter nor the catheter tip is intravascular, and terminates along the posterior medial aspect of the right thorax. There was a new development of a large fluid collection within the right hemithorax, which may represent a large right infusothorax from chemotherapy.

1 case question available

A: 1. Very important to do 2 views after a port placement.
2. When reading chest x rays always use the term overlying a structure and not use in a structure example RIJ catheter overlies right atrium and not tip of the RIJ catheter in the right atrium.

Case Discussion

The portacath was placed in OR under fluro guidance by surgeons. No static image was obtained post operatively.

Patient received chemotherapy via the port for 8 weeks. Despite this there has been good response to chemo therapy by the breast cancer.

Following the Chest X-Ray, fluoroscopy confirmed extravascular pleural course of portacath and confirmed on CT. The next day VATS performed and the port was removed; the pleural effusion was not bloody. At that time it was confirmed that the port was in pleural place all along and the chemotherapy was absorbed by the pleural membrane into blood stream effectively.

Important lesson: It is very important to ensure ports are intravascular by aspirating blood before infusing drugs.